Growing Need of GOOD IVF Centers in Male Infertility
Growing Need of GOOD IVFCenters
in Male Infertility
Between 12 and 15 million couples worldwide experience difficulty in conceiving and the trend is rising 20% will need help of IVF clinic. A male factor contributes to subfertility in 40-60% of these couples. Over the last few decades, the field of ART Technology & Good IVF centers have provided pregnancy to couples with male factor infertility.
Examination of male partner is neglected area & hardly done in current infertility practice in Delhi Similarly semen analysis is also not taken seriously by pathology lab.
A routine semen analysis by dedicated lab person in infertility clinic speaks volume about male partner, to determine the number and quality of sperm & to predict the fertilization potential of a male.
Oligozoospermia
When sperm are produced by ejaculation but in very low numbers, (<5 million)In-vitro Fertilization (IVF) along with Intracytoplasmic Sperm Injection (“ICSI”) by IVF specialists can help couples achieve a pregnancy. ICSI is performed by directly injecting a single sperm into one egg using highly sophisticated microscopic instruments. ICSI, was developed in Belgium by Gianpiero Palermo, has dramatically changed the treatment available for even the most severe male factor infertility. Now this facility of ICSI is available in good 50% IVF centre in Delhi.
Azoospermia, defined as complete absence of sperm from the ejaculate, is present in about 1% of all men and in approximately 15% of infertile men.
"Azoospermia” that is Men with zero sperm count can be divided into two broad groups:
Men who have an obstruction problem or blockage, meaning they are producing sperm, but the sperm can't get out Obstructive azoospermia (OA) or
Men who have a production problem, meaning they are not making sperm, a condition called "non-obstructive " azoospermia. (NOA)”
Men who have an obstruction problem or blockage, meaning they are producing sperm, but the sperm can't get out Obstructive azoospermia (OA) or
Men who have a production problem, meaning they are not making sperm, a condition called "non-obstructive " azoospermia. (NOA)”
Using a serum FSH and palpating the male reproductive ducts and size of the testis, fertility specialists can differentiate between obstructive azoospermia (OA) and Non-Obstructive Azoospermia (NOA) clinically. Specifically, an elevated FSH and small testicular size is consistent with NOA.
In, OA blockage can also be caused by a urinary tract infection or by the sexually transmitted diseases like chlamydia and gonorrhea. Infection of the epididymis can cause scarring and blockage, inhibiting the sperm from leaving the duct to fertilize an egg.
One of the most common causes of obstruction is vasectomy. More than a million men undergo vasectomy each year in this country for permanent birth control. With an increase in divorce rates, the demand for reversal of vasectomy is also growing. Approximately 1% of all infertile men are born with the congenital absence of the vas deferens.
Genetic testing of men with (NOA) has revealed that 10% to 15% are missing a small piece of their Y chromosome. This condition is called Y-chromosome micro deletion. The Y chromosome carries the genes that are responsible for producing sperm. Men who have decreased or no sperm count might be missing a small piece
of that Y chromosome. Unfortunately treatment of men with Y-chromosome micro deletion to have children ensures their male children will have the same infertility problem.
Until the mid 1990′s, donor sperm was the only treatment for azoospermia. A minor outpatient procedure called “TESA” (Testicular Sperm Aspiration) in IVF centre offering ICSI may be offered to obtain sperm directly from the testes where it is produced. If successful, the sperm can then be used with IVF/ICSI.
The most exciting new development in the field of male infertility is the ability to treat men with severe sperm production problems called non-obstructive azoospermia. Even though these men may have no sperm in their semen, we can now find sperm between the cells of the testicles in almost half of these cases. By using an operating microscope and doing micro dissection TESE, many researchers have been able to achieve pregnancies in half of those men in whom sperm can be found within the testicle.
Surgical retrieval of spermatozoa from testes combined with ART has given new hope to those patients previously considered infertile. In cases of surgically irreparable obstruction or in cases of CBAVD, Microsurgical Epididymal Sperm Aspiration (MESA) with standard IVF has been shown to yield fertilization and pregnancy. However, the results were poor and unpredictable. TESA is now a well-accepted technique in the treatment of men diagnosed with OA or NOA but requires ICSI due to the immature fertilization potential of testicular sperm. Since testicular biopsy is an invasive procedure, the efficient use of TESA would reduce surgical aspirations to a single sperm retrieval & than using cryopreservation.
Cryopreservation of TESA specimens can avoid repeated testicular biopsies in azoospermic patients in whom the only source of spermatozoa is the biopsy. Testicular sperm cryopreservation using a simple freezing protocol is promising in patients with AO and NOA augmenting the overall success achieved after surgical sperm retrieval.
In summary, TESA with ICSI has successfully treated azoospermia and offers approximately a 40% live birth rate from OA and NOA patients. Because of this technique, 90% of all infertile men, including half of all men with non-obstructive azoospermia, have the potential to conceive their own genetic child. The freezing and in vitro maturation of testicular biopsy specimens are useful approaches to the management of testicular biopsy samples from both OA and NOA patients. These techniques offer the possibility of several attempts at IVF/ICSI from a single testicular biopsy sample. Lifecare IVF has dedicated unit to treat such cases with very satisfactory result
Dr Abhishek Singh Parihar
MBBS ,MS , Fellow. Reproductive Medicine
Consultant – Reproductive Medicine
Lifecare Institute of Infertility & IVF
Dr. Sharda Jain
M.D. (PGIMER), MNAMS, FiCOGFIMSA,DHM,QM & AHO
Consultant : Reproductive Medicine
Programme : Director : Lifecare IVF
